Mark Zedrix A.

Mediario
BSN 3-C

CASE SCENARIO
A 49-yr-old man was admitted to as local hospital for evaluation of
severe hypocalcemia despite treatment with 0.5 μg calcitriol and oral
calcium supplementation. Diffuse bone pain and progressive muscle
weakness rendered him largely immobile. Despite preserved appetite,
his nutritional status was poor (weight, 46 kg; height, 161 cm). He also
reported increased frequency of bowel movements (up to 10 daily) and
looseness of stool. Laboratory testing revealed severe hypocalcemia,
and secondary hyperparathyroidism.

How does secondary hyperparathyroidism equate to hypocalcemia?

Secondary hyperparathyroidism is a condition in which a disease outside of the parathyroid glands
causes all of the parathyroid glands to become enlarged and hyperactive. The most common causes
of secondary hyperparathyroidism are kidney failure and vitamin D deficiency. In kidney failure,
kidneys do not convert enough vitamin D to its active form, and they do not adequately excrete
phosphate. When this happens, insoluble calcium phosphate forms in the body and removes calcium
from the circulation. Both processes lead to hypocalcemia and hence secondary hyperparathyroidism.
 NURSING CARE PLAN FOR SEVERE HYPOCALCEMIA
Cues Nursing Background Goals Nursing Intervention Rationale Evaluation
Diagnosis Knowledge

Long Short Term Ideal Actual

Term
Subjective data: Impaired Impaired physical After 72 hours of  Ensure the  For elimination of After 72 hours of
physical mobility is defined nursing safety of the obstacles in the nursing interventions,
 Diffuse bone mobility as the limitation in interventions, the environment. room that can the goals were met as
pain related to independent, patient will: impede activities, evidenced by:
 Progressive severe purposeful physical especially
muscle  perform  activities
hypocalcemia movement of the transferring and
weakness activities performed with
as evidenced body. A person ambulating
with the least the least
by diffuse with severe  Serves as the basis
amount of amount of
bone pain and hypocalcemia may in making an
Objective data: assistance assistance
progressive develop symptoms individualized plan
within the within the
 Severe muscle such as muscle of care
limits of  Assess for limits of
hypocalcemia weakness spasms, numbness  For prevention or
disease, functional disease,
despite and tingling in the early recognition
extremities, and  exercise level of  daily exercises
treatment with and treatment of
easy fracturing of daily within mobility. within the
0.5 μg calcitriol pressure ulcers
the bones. The the limits of  Check for limits of
and oral calcium  To detect untoward
diffuse pain and disease, skin disease,
supplementation causes of
progressive muscle  increase integrity.  verbalization of
 Laboratory prolonged bed rest
weakness cause the muscle increased
testing revealed or immobility
body to be largely strength, feeling of
severe  For pain
immobile.  evaluate pain  Note for strength,
hypocalcemia, management which
and quality progressing  verbalization
and secondary might increase
of thrombophle that pain is
hyperparathyroi patient
management controlled or
dism. , and bitis. performance and relieved, and
 be free from  Administer ability to move  absence of
complication pain  To determine the signs of
s of medication need for special complications
immobility. as ordered equipment or from
before utensils to increase immobility.
mobilizing. independence when
performing ADLs
 Increases
circulation and
muscle strength
and prevent
contractures

 Evaluate  Perform
how much active and  Can decrease the
assistance is passive range risk of
needed to of motion complications
perform exercises
ADLs daily.  For maximum
 Encourage mobility of the
early patient
ambulation.

 Assist with
practicing
transfers and  To note any
using untoward data
techniques in
moving.
  Monitor vital  To allow time to
signs during recover and
exercises conserve energy
closely.  Ensures the patient
engaging in
exercises regularly

 Consult
physical and
occupational
therapy as
necessary

 Allow for
rest periods
between
exercises.